03060188 (4) CI'T'Y OF CUPEWHNO
BUILDING DIVISION PERMIT CONTR?,CTORnINFORMATION
,Ni_ s of.,u_.. w"RiWP.jo;4 L3't23'.bb. 6 Pi T N-2
BUILDING ADDRESS: - BOYD THOMAS C AND JANE P PERMITNo03060188
OWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY NO. CONTROL N0.
ARCHITEMENGINCER: BUILDING PERMIT INFO
BGS ELECT PLUMB MO
�Oj LICENSED CONTRACTOR'S DECLARATION Job Description
Up 1 bercbop
y from that I am licensed under provisions of Chapter 9(commencing
IZW with Section
7")of Division Sol the Business and Prufcuiom CoCe.ind my[fee.is
<<�„ in full force and effect, REPLACE SIDING
'2License Class Lis.{ Ika}��1ra1 kr
:T•41
Dam.Contractor
ARCHITECTS DECLARATION
I understand my pl+na.halI Mused as public omoods
60 Liccnmd Pmfcssinnel
AUG 2 1 2003
OWNER-BUILDER exempt f DECLARATION
COO I hereby.(Gere that 11. exempt from Ne Cnntncmrs Licence Law for the
a0 following meson. torsi,n]I)L&Business
mpr improve.
detons Co de.Any city county BIII/ DING
<� which myvsitoa permit I,,construct,ue, pMr,nt for such
demolish,or repair any nnetum �/ L gY
pdoren itsiensedpaim minims the lM applicant for CohpermiuoBit aicense aw(Chmmcm
(com mcncing wit pontoon hlthe of Divisio of loo Co usinesandProfssw(COm)or Sq. Ft. Floor Area Valuation
(enmmcne xewith Section NMI of Division3 ofthe
eged Business and Professions Codc)ser
$ that he is exempt IMmfrom and the baso for the alleged exemption.Any violation of 37541021 . 00
Section 7031.5 by any applicant for a petrnisaubjects the applicant o a civil penally of APN Number Occupancy Type
not more than Brc hundred dollars($50)7.
❑1,as owner of the property,or my employeas with wages as their srde compensation,
Will do the work,end Ne awctum is not intended or offend for sale(Sem.70",Business —
.it Prode:fecsloa CoThe Contnet es License Law does oat apply m an owner of d Inspections
property who builds or improves thereon,and who doessuch work himselfor through his 102 — PIERS
own employees,provided that such improvements are not intended oroffemd for ale.If. 103 — UFER
however,the building or improvement Is sold within one you of completion,the Owner.
builder will have the burden of proving Nat he did not build or improve for purpose of 104 — REBAR
a10
1. 105 - ANCHOR BOLTS
❑I,uct wner property am 106 - SEWER & WATER
construct the project(Sec.]044,Business and Professions Code:)The Contractor's Li.
cetue Law does not apply to an owner,of property who Wilda of improves dsemon,and 202 - UNDERFLOOR PLUMBING
who convects for such projects with a eontnctorO licensed pursuant o the Consomme.
C low Law 203 - UNDERFLOOR MECHANICAL
lore exempt under Sec. ,B&PCfnnhla moon 204 - UNDERFLOOR FRAME
° D 7I-03 205 - UNDERFLOOR INSULATION
O ER'S MP ATI NDECLARA N
I thereby affirm under penalty of perjury ore of the following combustions: 301 — ROUGH PLUMBING
I have and will maintain a Cenlrcem of Consent to self-ituum for Wofkeis Comport. 302 — TUB & OR SHOWER
added,as provided for by Section 3700 of the land,Codd.for the pc f...nm of the 303 - ROUGH MECHANICAL
Work for whichthisp.Itisissued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code,for the performance of the work for which this Permit is laved. 305 — FRAME
My Worker,Comperteatinn TO......artier and Policy numMr arc: 306 — HOLDOWNS
Cartier: Policy No.: _
CERTIFICATE OF EX EM MON FROM WORKERS 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or Inc)
)Mir seninnneed not M completed if the permit is forone hundred dollars($100) 309 - EXTERIOR LATH
I cenify Nat in the pcfrnrmance of the work for which this permit is issued.I shall nm 310 - INTERIOR LATH
employ any Person in any mannerm as m Mcome subject to the Workers'Compensalion 311 — SCRATCH COAT
Lawsicant or California.Date
Appl313 - ROOF NAIL
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Code,you most
,J z forthwith comply with such provisions or this permit snailMseemed mwkcd. 502 — FINAL PLUMBING ENERGY
z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
F
I hereby alarm that there is a constrocti^n lendingagency for ss r fPerformance of 504 - FINAL BUILDING ENERGY
C'i ti Inc work for which this permit is issued(See.31197,Co.C.)
W q
Len car's Name 505 - FINAL ELECTRICAL
z <ndu,Add. 506 - GAS TEST
V p 1cenifythat Iban mad this application and state OIL thcsWminformation u 507 - FINAL PLUMBING
torten.1 agree to comply with all city and county ordinances and Rate laws misting m
p V building construction,and hereby authorise representative of this city to enter upon theFIN MECHA CAL
e Wvcmentioned pmpcny for iroleclion pu,poses.
Ow (We)agree to save,indemnify and keep harmless the city of Cupertino eg+inn O 9 FIN
i p1
Hail liLica,judgments,casts and capenadt which may In any way acerae against said City
t-) ,z ,n consequence of tho gmuti ng of this permil. 5 jj�7NG
?:'_rAppican
ICANT UNDERSTANDS AND ILL CDMPLY WITH ALL NONPOINT Issued by:5 WORKS Dale
CE REGULATIONS.
-0 Re-roofs
um oomaDa¢HAZA US MATERIALS DISCLOSURE Type of Roof
Willtheapplicant tore building oceuPamaloin or hendlc he'rudous memrial
ned by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Section 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
Yrs p ,
Will the applicant orfftuure bending Occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
W>ardnus air mnnminants as dcMcd by the Bay Am.Air Quality Maot,nont all new materials for inspection.
District?
❑yes 9No
I have read the h loccous materials myuirements under Chapter 6.95 of the Califoe
nits Health&Safety COO,Sections 25505,25533 and 25534,1 understand that if the building
\. Jtcn Out currently hove a nnen0 that it is my r pourat lily m nnufy the occupant of the
m cntswhica banetpriorwiuucm'sCerife.w.fCce eney. Signature of Applicant Date
ow ser+ore asdagent Data All roof coverings to be Class"B" or better